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IEEE Member Group Dental Insurance Plan

A healthy smile could mean better health. To help maintain your smile, consider the IEEE Member Group Dental Insurance Plan.

Regular visits to the dentist can be important to your overall health. The IEEE Member Group Dental Insurance Plan, underwritten by MetLife can help you get the protection you need while making it easier and more affordable to see your dentist regularly.

Now that’s something to smile about.

Freedom of choice to go to any dentist. Additional savings* when you visit a network dentist. Educational tools and resources to help you make better choices. Service where and when you want it.

1Savings from enrolling in a dental benefits plan will depend on various factors, including how often participants visit the dentist and the cost of services covered.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact us for costs and complete details.

Group dental insurance policies featuring the MetLife Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166.

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The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services — both in and out of the network.

The goal is to deliver affordable protection for a healthier smile and a healthier you. You also get great service and educational support to help you stay on top of your care.

You have the flexibility to visit any dentist — your dentist — and receive coverage under the plan. Just remember that non-participating dentists haven’t agreed to charge negotiated fees. That means you usually save more dental dollars when you go to a participating dentist.

If you prefer to stay in the network, there are thousands of general dentists and specialists to choose from nationwide — so you are sure to find one who meets your needs. Plus, all participating dentists go through a rigorous selection and review process.1 This way you don’t need to worry about quality. You also don’t need any referrals.

To check out the general dentists and specialists in the PDP network, visit www.metlife.com/dental.

Your out-of-pocket costs are usually lower when you visit network dentists. That’s because they have agreed to accept negotiated fees that are typically 15 to 45% less than average dental charges in the same community. This may help lower your final costs and stretch your plan maximum. Negotiated fees may even extend to non-covered services and services provided after you've reached the plan maximum.2

Service where and when you want it.

MyBenefits, your secure self-service website through MetLife, is available 24/7.3 You can use the site to get estimates on care or check coverage and claim status. Plus, if you are on the go and need to find an in-network provider, view a claim or see your ID card, there’s an app for that.4 Search “MetLife” at iTunes App Store or Google Play to download the app.5

The right dental care is an essential part of good overall health. That’s why you and your dentist get resources to help make informed decisions about your oral health. You’ll find a range of topics on our online dental education website, www.oralfitnesslibrary.com. Read up on the link between dental and overall health, kid’s dental health and more. You can also put your oral health to the test by taking an online risk assessment.

Once enrolled in the MetLife Dental Plan, you will have access to the MetLife Vision Access Program. With this program you will have access to discounts on vision services at participating providers. More information is available on this service at www.metlife.com/mybenefits.

Exclusions

This plan does not cover the following services, treatments and supplies:

  1. Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we have deem experimental in nature;
  2. Services for which you would not be required to pay in the absence of Dental Insurance;
  3. Services or supplies received by you or your Dependent before the Dental Insurance starts for that person;
  4. Services which are primarily cosmetic (For Texas residents, see notice page section in certificate);
  5. Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for:
    – Scaling and polishing of teeth; or
    – Fluoride treatments;
  6. Services or appliances which restore or alter occlusion or vertical dimension;
  7. Restoration of tooth structure damaged by attrition, abrasion or erosion;
  8. Restoration or appliances used for the purpose of periodontal splinting;
  9. Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco;
  10. Personal supplies or devices including, but not limited to: water picks, toothbrushes or dental floss;
  11. Decoration, personalization or inscription of any tooth, device, appliance, crown, or other dental work;
  12. Missed appointments;
  13. Services
    – Covered under any workers’ compensation or occupational disease law;
    – Covered under any employer liability law;
    – For which the employer of the person receiving such services is not required to pay; or
    – Received at a facility maintained by the Employer, labor union, mutual benefit association or VA hospital;
  14. Services covered under other coverage provided by the Employer;
  15. Temporary or provisional restorations;
  16. Temporary or provisional appliances;
  17. Prescription drugs;
  18. Services for which the submitted documentation indicates a poor prognosis;
  19. The following when charged by the Dentist on a separate basis:
    – Claim form completion;
    – Infection control such as gloves, masks, and sterilization of supplies; or
    – Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide;
  20. Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food;
  21. Caries susceptibility tests.
  22. Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;
  23. Other fixed Denture prosthetic services not described elsewhere in this certificate;
  24. Precision attachments, except when the precision attachment is related to implant prosthetics;
  25. Initial installation of a full or removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;
  26. Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental insurance, except for congenitally missing natural teeth;
  27. Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it;
  28. Implants including, but not limited to any related surgery, placement, restorations, maintenance, and removal;
  29. Repair of Implants;
  30. Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;
  31. Diagnosis and treatment of temporomandibular joint (TMJ) disorders. This exclusion does not apply to residents of Minnesota;
  32. Repair or replacement of an orthodontic device;
  33. Duplicate prosthetic devices or appliances;
  34. Replacement of a lost of stolen appliance, Cast Restoration or Denture; and
  35. Intra and extraoral photographic images.

Your dental plan provides that where two or more professionally acceptable dental treatment for a dental condition exist, your plan bases reimbursement, and the associated procedure charge, on the least costly treatment alternative. If you and your dentist have agreed on a treatment which is more costly than the treatment upon which the plan benefit is based, your actual out-of-pocket expense will be: the procedure charge for the treatment upon which the plan benefit is based, plus the full difference in cost between the Negotiated Fee or, for out-of-network care, the actual charge, for the service rendered and the Negotiated Fee or R&C fee (if out-of-network care) for the service upon which the plan benefit is based. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pretreatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plans reimbursement for those services, and your out-of-pocket expense. Procedure charge schedules are subject to change each plan year. You can obtain an updated procedure charge schedule for your area via fax by calling 1-800-942-0854 and using the MetLife Dental Automated Information Service.

Coverage is provided under a group insurance policy (Policy Form GPN99) issued by Metlife. Coverage terminates when your Membership in IEEE ceases, when your dental contributions cease or upon termination of the group policy by the Policyholder. The group policy terminates for non-payment of premium and may terminate if participation requirements are not met or, if the Policyholder fails to perform any obligations under the policy. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatments is finished within 31 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.

Dental Insurance
BenefitSmart Help to understand the most common employee benefits and the steps to take to help fill in any gaps you may find.
MetLIfe Oral Health Library An extensive library full of oral health educational articles and tools.

A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for services provided to plan members. Negotiated fees typically range from 15-45% below the average fees charged in a dentist’s community for the same or substantially similar services.*

*Based on internal analysis by MetLife. Savings from enrolling in a dental benefits plan will depend on various factors, including how often members visit participating dentists and the cost for services rendered. Negotiated fees are subject to change. Negotiated fees for non-covered services may not apply in all states.

There are thousands of general dentists and specialists to choose from nationwide — so you are sure to find one who meets your needs. You can receive a list of these participating dentists online at www.metlife.com/mybenefits or call 1-800-942-0854 to have a list faxed or mailed to you.
All services defined under your group dental benefits plan are covered. Please review the enclosed plan benefits to learn more.
Negotiated fees may extend to services not covered under your plan and services received after your plan maximum has been met, where permitted by applicable state law. If permitted, you may only be responsible for the negotiated fee.

* Negotiated fees are subject to change. Negotiated fees for non-covered services may not apply in all states.

Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. He or she hasn’t agreed to accept negotiated fees. So you may be responsible for any difference in cost between the dentist's fee and your plan's benefit payment.
Yes. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.* The website and phone number are for use by dental professionals only.

* Due to contractual requirements, MetLife is prevented from soliciting certain providers.

Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive e-mail alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/mybenefits or request one by calling 1-800-942-0854.
Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.
If you have MyBenefits you can access the Dental Procedure Fee Tool. You can use the tool to look up average in- and out-of-network fees for dental services in your area.* You'll find fees for services such as exams, cleanings, fillings, crowns, and more. Just log in at www.metlife.com/mybenefits.

* The Dental Procedure Fee Tool application is provided by go2dental.com. Inc., an independent vendor. Network fee information is supplied to go2dental.com by MetLife and is not available for providers who participate with MetLife through a vendor. Out-of-network fee information is provided by go2dental.com. This tool does not provide the payment information used by MetLife when processing your claims. Prior to receiving services, pretreatment estimates through your dentist will provide the most accurate fee and payment information.

Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits.** Please remember to hold on to all receipts to submit a dental claim.

*International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife and any of its affiliates, and the services they provide are separate and apart from the benefits provided by MetLife. ** Refer to your dental benefits plan summary for your out-of-network dental coverage.

Yes. Your dental coverage continues as long as you remain an IEEE member and pay the appropriate premium when due, and the group policy remains in force. Similarly, your family is covered as long as you remain insured and the person continues to remain your dependent.

We're here to help! Please contact us in whatever manner is most convenient for you.

Program Administrator

IEEE-Sponsored Insurance Program Administrator
12421 Meredith Drive
Urbandale, IA 50398
1-800-493-IEEE (4333)
ieee.service@mercer.com
7:30 a.m. to 6:00 p.m. Central, Monday through Friday
8:00 a.m. to 5:00 p.m. Central, Saturday and Sunday

MetLife
Metropolitan Life Insurance Company, New York, NY

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